The federal Agency for Health Care Policy and Research is reviewing its method of writing and distributing clinical practice guidelines as it nears the end of its "first wave" of guideline development.
The agency, part of the Public Health Service, was expected to release one more guideline-on treatment of pressure ulcers-before the end of the year. It has issued 14 guidelines over two years on topics ranging from the management of cataracts to the treatment of lower-back pain.
But the agency will not develop new guidelines until after it finishes a "thorough top-to-bottom review" of the program in February 1995, said Clifton Gaus, its administrator.
The agency is writing and releasing guidelines to improve quality of care and reduce ineffective or inappropriate services. Each guideline costs $500,000 to $1 million to develop.
In an interview, Mr. Gaus said the review of the guideline program is an attempt to respond to criticism from providers who say the guidelines are cumbersome, take too long to develop or do not fit into their needs.
The agency is seeking ways to speed development of guidelines, select topics in which providers are interested, and help providers receive and adopt guidelines.
"Most everyone believes there is a real unique role and contribution for the agency in the evaluation of the underlying science," Mr. Gaus said. "That's an exhaustive, costly, time-consuming process that not every managed-care plan or insurance company or individual physician can do."
Mr. Gaus said agency officials met with representatives of the Group Health Association of America on Dec. 8 to determine how the agency could work more closely with the managed-care industry to develop guidelines.
Mr. Gaus' comments came on the heels of criticism of the agency by the Physician Payment Review Commission. The commission surveyed managed-care plans on their use of all clinical practice guidelines.
When asked to rank 10 guidelines that they use most frequently, managed-care plans said they use those developed by the agency less frequently than those written by other groups such as specialty societies.
The commission, in developing its annual report to Congress on physician payment issues in January 1995, is expected to consider advising changes in the agency's role, its work on guidelines in general or its guideline development process.